Histamine Intolerance

Updated 4/2023

Headaches, rashes, gastrointestinal issues, fatigue, brain fog…sure there are a lot of potential causes to these seemingly unrelated symptoms.

These symptoms are very common in our typical clients and we usually find that diet plays a role. Lately, we have had several clients where intolerance to histamine (a chemical naturally occurring in food and the body) is causing many of these symptoms.

Could Histamine Become The New Gluten?

So many clients have been presenting with histamine intolerance, that I wanted to blog about it.

It’s hard to tell if histamine intolerance is increasing in the population, or if the holistic medical community is just getting better at recognizing this condition. Either way, whenever you have an intolerance to any food or chemical, you want to get to the bottom of WHY you have that intolerance.

Ever feel a little out of it after eating? Maybe it’s a headache, anxiety, or you have a bad case of “brain fog”. Maybe you have allergic-like reactions to certain foods. Ever feel itchy or have trouble breathing after you eat? Ever get a flushed face after drinking red wine?

If you are experiencing these symptoms then you may have histamine intolerance.

What is Histamine?

Histamine is a chemical that occurs naturally in foods.Some foods contain greater amounts of histamine than others.

Histamine is also naturally produced in the body. Histamine is involved in immune responses, plays a role in regulating gut function and numerous other processes throughout the body.

What is Histamine Intolerance?

Histamine intolerance is a condition of an increased build-up of histamine in the body. When the body is overloaded with histamine, an array of allergy-like symptoms can occur.

The build-up of histamine is usually caused by decreased activity of the enzymes that break down histamine.

There are two enzymes responsible for breaking down histamine: diamine oxidase (DAO) and Histamine N-methyltransferase (HNMT).

If you suffer from histamine intolerance, the function of these enzymes is likely impaired.

Decreased function of the enzymes that break down histamine can be genetic or can develop from a variety of factors. These factors may include medical conditions, alcohol or drug use, or medication that may have DAO-blocking properties.

If your symptoms are being caused by a medication, drugs or alcohol – getting rid of those symptoms is as simple as discontinuing the use of the substance. Of course, never discontinue a medication without the approval of your doctor.

Histamine Intolerance Medications to Avoid

Check with your doctor to see if any of your medications cause histamine to be release or block the DAO enzyme from working optimally.

Here is a list of common medications that can potentially cause histamine intolerance (2):

Contrast media
Muscle relaxants
Narcotics
Pain medications
Local anesthetic
Antihypotonics
Antihypertensives
Antiarrhythmics
Diuretics
Prokinetics
Antibiotics
Mucolytics
Broncholytics
H2-receptor antagonists
Cytostatics
Antidepressants

Symptoms of Histamine Intolerance

Symptoms of histamine intolerance can be chronic, sporadic, or sudden at onset and can include:

Headaches/dizziness
Rashes/itching
Diarrhea/vomiting
Abdominal pain/spasms
Chronic constipation
Flatulence
Panic attacks
“Leaden exhaustion” – during or after a meal; sleep does not restore vitality
Chills, shivers, discomfort or low blood pressure

These symptoms are caused when the excess histamine binds to receptors in your smooth muscles causing it to contract, dilate, become more permeable or increase mucus production. Other effects of this reaction include an increase in stomach acid and increased pain.

Symptoms may mimic other food intolerances or conditions. It is important to exclude conditions that can cause similar symptoms such as a food sensitivity, celiac disease, non-celiac gluten sensitivity or an intolerance to something else such as lactose or fructose.

How Do I Know if Histamine Intolerance is the Cause of My Symptoms?

If you have already excluded the above-mentioned food-related possibilities (food sensitivities, celiac disease, non-celiac gluten sensitivity or an intolerance to lactose or fructose) and are still experiencing symptoms you may want to explore the possibility of histamine intolerance.

Because the underlying issue for those suffering from histamine intolerance is not an allergic response, but an overload of histamine in the body, allergy testing for histamine intolerance is not reliable.

The best way to determine if you have histamine intolerance is by following an elimination diet. To do this, exclude foods high in histamine for four weeks while keeping a food and symptom diary. If you notice you are feeling better and having fewer symptoms, you may very well have an intolerance to histamine.

If you add higher histamine foods back to your diet and have a negative reaction to those foods, you can be just about certain that histamine is playing a role in your symptoms.

How to Treat Histamine Intolerance

Management of histamine intolerance consists of following a low-histamine diet to the level of the individual. It is important to keep in mind that the amount of histamine tolerated will vary from person to person.

Low histamine food lists vary dramatically depending on the source. Additionally, some foods may contain different levels of histamine depending on their ripeness or how they are stored

Top Histamine Containing Foods (1, 2):

Fermented foods (dairy, vegetables, meats, or beverages)
Vegetables: Eggplant, Spinach, Tomato
Cheese
Beverages: Any alcohol, kombucha, broths
Fish and seafood (smoked, salted, or canned)
Soy (soy sauce, tamari, tempeh, etc.)
Old leftovers, spoiled foods
Vinegars
Yeast containing foods
Dried foods
Canned foods

Eliminating foods from your diet can reduce the nutritional quality of your diet. Therefore, it is important for anyone following a diet that restricts foods to maintain a nutritional balance. Substituting foods of equal nutritional value of those that are restricted becomes an essential part of management.

While histamine is always produced by the body during digestion, some foods cause the body to release more histamine than other foods. Some people choose to avoid these foods during the elimination phase of the diet as well:

Avocado
Tea
Bananas
Chocolate
Citrus fruits
Cow’s milk
Licorice
Nuts
Pineapple
Pork
Shellfish
Strawberries
Wheat Germ

Not all histamine containing or histamine-releasing foods have been identified so you might discover intolerance to something not listed as you learn how to best manage your symptoms.

You may find you can tolerate some histamine containing foods, but not others, as each person with histamine intolerance has a different level of histamine they can tolerate.

It is a good idea to enlist the help of a registered dietitian in this process. We recommend starting by only eliminating the high histamine containing foods first.

Triggers for Histamine Intolerance

Things other than foods can cause the body to release histamine. If you have a histamine intolerance, these things can create symptoms for you:

Allergic reactions to things in the environment like dust, mold, or pollen
Normal immune responses to foreign invaders like viruses
High levels of oxidized LDL cholesterol (3)
Cold temperatures (4)
Shock and trauma (5)

Supplements for Histamine Intolerance

Histamine Digest – The use of a DAO supplement to help breakdown histamine from ingested food also may improve symptoms. This product by Seeking Health combines vitamin C (a cofactor for DAO) + DAO extract.
Probiota HistaminX – Unique probiotic supplement containing histamine degrading probiotic strains
Natural D-Hist – Contains vitamin C, stinging nettle, NAC, bromelin and quercetin to help reduce histamine build up specifically in the nasal and sinus areas.
Take antihistamines before taking medications that increase histamine buildup (discuss this strategy with your doctor)
Try taking antihistamines before meals (although this does not address the actual problem but is rather a bandaid for your symptoms)

Histamine Intolerance vs MCAS

Allergy cells known as mast cells are responsible for triggering immediate allergic reactions by releasing substances called “mediators”. These mediators are either stored inside the mast cells or produced by them, and they cause various allergic symptoms.

MCAS, mast cell activation syndrome, or MCAD, mast cell activation disorder, happens when mast cells release too many mediators too often, even in response to things that are normally harmless, such as certain foods or chemicals in the environment.

MCAS is characterized by repeated episodes of anaphylaxis which can include these symptoms (6):

itching
hives
swelling
flushing
rapid pulse
low blood pressure
fainting
difficulty breathing or shortness of breath
severe diarrhea
nausea
vomiting
stomach cramps

Histamine intolerance occurs when the body cannot break down histamine properly, leading to a buildup of histamine in the bloodstream (7). Unlike in MCAS, where the body is overproducing all mediators (not just histamine).

According to the American Academy of Allergy, Asthma and Immunology, the lab tests run to diagnose MCAS include serum mast cell tryptase (which must be drawn within 2 hours of an episode) and a 24 hour urine collection to test N-methylhistamine, 11B -Prostaglandin F2α (11B-PGF2α) and/or Leukotriene E4 (LTE4).

If you suspect MCAS, we recommend working with an allergist to get it diagnosed because the treatment protocol is different than histamine intolerance.

Conclusion

The symptoms occurring with histamine are systemic and very common making it difficult to identify.

If you have tried these tips and are still struggling with symptoms, we recommend working with a skilled dietitian to get more individualized support!